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Please pent or type.(Form designed for use on sli 12-pitch)typewriter. FortnApproved.OMR No.2056-0039 <br /> UNIFORM HAZARDOUS 1-.G'teramrm,Nuatw 2.Pagetof 3 EmwWrWRespam Plane l gA�u re� +g <br /> WASTE MANIFEST f� '". Z7. . -5 •I.:'.•f_".;tnt`7 i o m8 f•f3 JJK <br /> S.Oaiiela0>ra-Nameaid#laing'Addrass :`:"� Gernratds S&Addres3 IndMereM tan mailing addims) <br /> Ise, f* . . ) _.. r.. <br /> C.-1r11 7W f cf. <br /> Gamramfs Pion: �:_'.'{ ./ a' IL.-x <br /> 6: mepoilm l Cdrpry:MW U$,FYAlDNUMbW <br /> f. :.a <br /> 7.Trenepale20anpairy Name U.S'EPAID Numhar <br /> 8 Naraei!19. aM US.EPAIDNunEr <br /> rr�L:# i /� >•,tixi%s'.,3 ,`�F''{s J4SF ... .,, . ... <br /> Fack es <br /> fi=i*l tS�Fr.Y ti. SEc .ia a{�r. x�".r•x:(.. �dTlf t. + �..., f 3 'i . . __. .... <br /> Paaic <br /> gy 96.U.S OOTDastriplon(iaMWg Prapaf$NppapNme,N®rd Class,DNurter,. 10.Contains 11-Trial12Un1 13.Waste Codes <br /> RM 0dPaddlg&0W0fWW)) No.. Typo Oae'r iy_ WlfV, ... <br /> 0 If•'�rr12°fi.�a..Vua-7S f �'f,4<={fir.^' r i,+r r.:Ti <br /> w <br /> 3. <br /> 4. . . <br /> 14.Spedm Harldelg Insaumons and Addaonal IMomatidn 1 - <br /> 15. GBtFRATOR'SrOFF9tOR'S CERTFICAl1ON:Thereby declare met the wMert5ofCds me fidy and sop+ablydett'ima?'A' 14 ?Rl?aer WM name.and am-dassdW padlaged: <br /> marked and tibeN3r61nmNed,am areina6iAkp&ds N p'rtperduidtlontor traapwlactardngb aPpOoble nNrnadonel as re§raf W—rtm reg AA.-I*ibd dwmarn and i am tla Pmrmy, <br /> EWoW,,I cadfyWda ivotentabfthis coaagmanfcanfanndame term of daaaaikQ EPAAdmo*b* etofConsenF <br /> ION*that the WasaaabaYnbation stmemert'idenafietl in 40'CFk26227(a)(if I m aUW parity generate)'Or(b)fdl*6 a and grrertltygenerzav)is aua <br /> P leciTyped Name 5grek.a ! .Manu . .w 'yem <br /> F 16.INxratlaW Stdpmenk ❑lmpodb U.S. ❑ ., <br /> Z Fxpod(mm U:S. ForDah,la n Us. <br /> ext <br /> Trars{arlera4raene lfa�p„yr _ - Date�'dn9 U.5.: <br /> *17.Tra�dkrfCmoMedpyrIM6M1Red6b[H _ <br /> pK fiatia'a C `.-. .. <br /> Sgamie Morlb DW i <br /> } 18.DlspePeil9', - s- <br /> IF—1 l <br /> 19e DeeaPan"itkaft SDaoe ❑ Quantity ❑Type LJReaLa ❑Panel Refection ❑Wl Reprflyre s <br /> Mandest RafuerlMNambN: r,.. ,.: <br /> 16b Aftemale Fagfily(or Genembe) U S EPAID Nwbe .. <br /> J <br /> E FaW.Phone: - <br /> w I&S &m ofAbnQte FadM(orGenealorl. a Modh Day Yeef• <br /> H19.Hazardous Wavle Repad Manapawt MdwdCodes(ie treaanen,dspoeal;aridmcydng sysmia) .. <br /> 20.Dasignaad Fao4Owneror Opemton CerdkatlonofrecelptofhazardousmatwWsa mdbymemaafesteaceptasndadi6nen18a ' - <br /> Pnrned7ypetlName Sgnaeae 'iWnm ay Year <br /> - <br /> EPA Form 8700-22(Rev.3-05) Prevnus editions are obsolete. <br /> G �B'S INITIAL COPY <br />